Button Melissa L, Westra Henny A, Hara Kimberley M, Aviram Adi
a Department of Psychology , York University , 4700 Keele Street, Toronto , Ontario , Canada M3J 1P3.
Cogn Behav Ther. 2015;44(1):44-53. doi: 10.1080/16506073.2014.959038. Epub 2014 Oct 3.
Resistance and ambivalence about change are increasingly recognized as important determinants of treatment outcomes. Moreover, resistance and ambivalence are thought to be theoretically related in that clients who are more ambivalent about change are more likely to demonstrate resistance to the process and tasks of treatment. In the context of cognitive behavioural therapy (CBT) for generalized anxiety disorder, the present study simultaneously examined early resistance and ambivalence using two observer-based coding systems in order to determine their inter-relationship and, importantly, to investigate their relative contributions to outcome. Resistance was also coded during mid-treatment in order to investigate possible mediation pathways. Early ambivalence (clients' arguments against change or counter-change talk) was found to be no longer related to outcomes when early resistance was taken into account, suggesting that disharmony in the therapeutic relationship is more important to outcomes than ambivalence per se. Moreover, mid-treatment resistance partially mediated the relationship between early resistance and post-treatment worry severity. That is, higher early opposition to therapist direction is related to poorer outcomes, in part because it is associated with greater resistance during the working phase of CBT. The findings underscore the critical need for therapists to be sensitive to identifying resistance early and throughout treatment.
对改变的抵触和矛盾情绪日益被视为治疗结果的重要决定因素。此外，抵触和矛盾情绪在理论上被认为是相关的，因为对改变更为矛盾的来访者更有可能表现出对治疗过程和任务的抵触。在针对广泛性焦虑症的认知行为疗法（CBT）背景下，本研究使用两种基于观察者的编码系统同时考察了早期的抵触和矛盾情绪，以确定它们之间的相互关系，重要的是，研究它们对治疗结果的相对贡献。在治疗中期也对抵触进行了编码，以研究可能的中介途径。当考虑到早期抵触时，发现早期矛盾情绪（来访者反对改变或反驳改变的言论）与治疗结果不再相关，这表明治疗关系中的不和谐对治疗结果比矛盾情绪本身更重要。此外，治疗中期的抵触部分中介了早期抵触与治疗后担忧严重程度之间的关系。也就是说，对治疗师指导的早期更高程度的反对与更差的治疗结果相关，部分原因是它与CBT工作阶段更大的抵触相关。这些发现强调了治疗师在治疗早期及整个治疗过程中敏锐识别抵触情绪的迫切需要。
